Abstract and Introduction
Abstract
Background Several drug classes are known to be associated with serious upper gastrointestinal bleeding (UGIB), among others NSAID, low-dose acetylsalicylic acid (ASA), vitamin K antagonists (VKA), clopidogrel and selective serotonin reuptake inhibitors (SSRIs). There are few data on how and to what extent these drugs are reintroduced in patients who have been discharged after a bleeding episode related to any of them.
Aim To assess if physicians re-prescribed potential causative drugs after an episode of UGIB and to explore whether drugs with antihaemostatic action (DAHA) are re-prescribed without a gastro-protective agent.
Methods By use of the Kaplan–Meyer method, we estimated the time from UGIB to re-prescribing for 3652 cases who were all admitted to hospital with a diagnosis of serious upper gastrointestinal bleeding from 1995 to 2006. Data on drug exposure were retrieved from a Danish prescription database, a recent study on drug-related UGIB, and The National Board of Health in Denmark.
Results One-year rates of re-prescribing after UGIB were; 82%, 25%, 43%, 68%, 55%, 71% for SSRIs, NSAID, low-dose ASA, VKA, clopidogrel and dipyridamol, respectively. However, re-prescribing rates without proton pump inhibitors (PPIs) were markedly lower 25%, 3%, 5%, 1%, 17% and 6%, respectively. Non-users of DAHA had a prevalence of PPI use of about 30% a few months after an UGIB.
Conclusions Drugs with antihaemostatic action are re-prescribed to a large extent after an episode of upper gastrointestinal bleeding, but usually covered by PPIs. This use of PPI is specific for users of drugs with antihaemostatic action.
Introduction
Upper gastrointestinal bleeding (UGIB) is a serious condition. The reported fatality rate is between 5–14% and recently a recurrence rate of 17.5 per 1000 person years during a mean follow-up of 3 years was reported. Moreover, it is well established that gastrointestinal bleeding is the most common serious bleeding complication from the use of long-term antiplatelet therapy.
Data are very scarce on how physicians re-prescribe potential causative drugs after an episode of UGIB that apparently is associated with one of these agents. Use of proton pump inhibitors (PPIs) is an effective prophylactic measure against UGIB in patients taking nonsteroidal anti-inflammatory drugs (NSAID) and ASA. If potentially causative drugs are re-prescribed to a large extent, it would also be of interest whether this group of patients are prescribed PPIs.
We undertook this study to describe the extent of re-prescribing of causative agents in a large group of drug-related UGIB, and we particularly focused on re-prescribing without PPI coverage. The data originated from a previous study on drug-related UGIB by this group. Our focus was on accounting for actual prescribing behaviour rather than a normative analysis of guideline adherence.